Archive for April, 2011

What is that ‘cracking’ sound when I am treated and adjusted by my Chiropractor?

I see a number of patients who have never been to a Chiropractor before and when I explain the Chiropractic treatment involving the manipulation/adjustment and they may hear a ‘cracking’ sound I see facial expressions ranging from interested to horrified! Others know have heard about Chiropractic adjustments and are apprehensive or merely intriqued.
So what happens to cause the cracking sound?

Opposing joint surfaces are in contact separated by a thin layer of synovial fluid, the fluid is found in every joint in the body and acts like lubricant. A small amount of tension applied to the joint separates the joint surfaces but the gap is filled with synovial fluid.

Dissolved gasses are released within the synovial fluid near the ligament/fluid interface; within a fraction of a second the gasses join to form a single bubble within the joint capsule.

The audible release, ‘crack’ is caused by a process whereby a sudden decrease in intracapsular pressure causes dissolved gasses in the synovial fluid to be released into the joint cavity. Once a joint undergoes cavitation (cracking), the force-displacement curve changes and the range of motion of the joint increases. The gasses released from the synovial fluid make up about 15% of the joint volume and consist of approximately 80% carbon dioxide. At this point, the joint has distended by a significant difference and the joint cavity now contains a gas bubble within the synovial fluid. The external force is equal to the

Cracking joints yourself doesn’t produce damage by may lead to problems later in life.

Researchers compared the incidence of osteoarthritis in nursing home residents with histories of continual joint cracking and those without. No statistically significant difference was identified showing that cracking of the joints did not increase the chance of arthritis. Further researchers continued this work looking at 300 patients aged 45 and over. Only 26% of this population was found to use knuckle cracking and this had no correlation on the incidence of osteoarthritis of the hand joints.

Other research did show that although continued habitual joint cracking does not correlate with arthritic changes, it did cause the loss of grip strength and increased soft-tissue swelling in the studied patients.

However, as the Chiropractic adjustment is done at a fast speed the surrounding ligamentous, muscular and soft tissue structures remain unaffected. For people who continually ‘crack’ their spines the adjustments they do are slow enough to stretch the muscles and ligaments eventually leading to increased movement in the joint called hyper-mobility which can cause pain and problems of its own.

What if there is no crack?

A simple study (Herzog) used a mixture of chiropractic patients and subjects with no symptoms to compare the responses of (high-velocity, low-amplitude (HVLA)) ‘manipulation’ treatments at with those that did not ‘crack’. The response appeared to be the same, whether or not a cracking sound was recorded. Furthermore, sham adjustments (adjustments that are done ‘wrong’ and not to treat the patient but simply fool them into thinking they had a proper treatment), never yielded measurable responses, although the cracking was actually sometimes present. Thus, it was apparent that in this instance the cracking sound is not actually essential for eliciting the observed reflex response following an adjustment, it simply needs to be done correctly.

The Chiropractic adjustment including the cracking sound are a very effective way of treating conditions related to the joins muscles and nerves of the body. The adjustment will not be painful and if you are not comfortable further techniques can be used for treatment.

What does the adjustment and cracking do?

  • Increasing movement in restricted joint
  • Inhibition of pain and increased pain tolerance
  • Relaxation of spinal muscles
  • Stimulation of the nervous system (viscerosomatic reflex)
  • Relief of nerve compression/irritation

Here at Camden Chiropractic, Camden Town, North London I will use all the most up to date techniques including manipulation to get you out of pain as quickly as possible and then keep you that way.

If you have any further questions please get in touch and I will be happy to talk them through with you.

Back Pain – The Facts

Some amazing statistics about lower back pain released by ‘Backcare’ the Charity Camden Chiropractic works with promoting the effects of back pain in the population and offering an option to reduce the impact it has;

  • Back pain is very common; according to a survey published in 2000 almost half the adult population of the UK (49%) report low back pain lasting for at least 24 hours at some time in the year.
  • It is estimated that four out of every five adults (80%) will experience back pain at some stage in their life.
  • Although in most cases back pain is nothing serious and disappears spontaneously, the sheer number of people affected makes it a very costly condition imposing a considerable burden on the individual and society.
  • Simple measures can be taken to reduce the chances of developing back pain and thereby reducing the impact of existing back pain.

NUMBER OF PEOPLE WITH BACK PAIN

  • In industrialised countries, up to 80% of the population will experience back pain at some stage in their life. During any one year, up to half of the adult population (15%-49%) will have back pain.
  • The number of people with back pain increases with advancing age, starting in school children and peaking in adults of 35 to 55 years of age. Back pain is just as common in adolescents as in adults.

CAUSES OF BACK PAIN

  • In most cases it is very difficult to identify a single cause for back pain. In about 85% of back pain sufferers no clear pathology can be identified.
  • The following factors could contribute to back pain:
    Having had back pain in the past, smoking and obesity.
    Physical factors such as heavy physical work, frequent bending, twisting, lifting, pulling and pushing, repetitive work, static postures and vibrations.
    Psychosocial factors such as stress, anxiety, depression, job satisfaction, mental stress.

RECOVERY FROM BACK PAIN

  • Up to 7% of people with acute back pain will develop chronic back pain. These chronic patients have considerable discomfort and account for approximately 80% of the social and health care costs.

THE COSTS OF BACK PAIN

  • The National Health Service spends more than £1 billion per year on back pain related costs, this includes:
    £512 million on hospital costs for back pain patients.
    £141 million on GP consultations for back pain.
    £150.6 million on physiotherapy treatments for back pain.
  • In the private healthcare sector £565 million is spent on back pain every year.
  • This brings the healthcare costs for back pain to a total of £1.6 billion per year.
  • In addition there are other (indirect) costs. The Health and Safety Executive estimates that musculoskeletal disorders, which include back pain cost UK employers between £590 million and £624 million per year.
  • The total cost of back pain corresponds to between 1% and 2% of gross national product (GDP).
    Other European countries report similar high costs; back pain related costs in The Netherlands in 1991 were more than 4 billion euro. For Sweden in 1995 these were more than 2 billion euro.

THE IMPACT OF BACK PAIN ON THE INDIVIDUAL

  • Back pain, in particular persistent back pain (i.e. <3 months), can have a significant impact on people’s lives. It frequently reduces their quality of life and adversely affects their family and social relationships.

THE IMPACT OF BACK PAIN ON WORK AND SICK LEAVE

  • Nearly 5 million working days were lost as a result of back pain in 2003-04. This means that on any one day 1% of the working population are on sickness leave due to a back problem.
  • Back pain is the number 2 reason for long term sickness in much of the UK. In manual labour jobs, back pain is the number one reason.

THE TREATMENT OF BACK PAIN

  • Nearly 40% of back pain sufferers consulted a GP for help; 10% visited a practitioner of complementary medicine (osteopaths, chiropractors and acupuncturists).
  • When experiencing back pain it is very important to stay active. Bed rest will only make the pain worse.
  • Physical exercise can be a very effective method to reduce the pain and discomfort that long-term pain sufferers experience.

Don’t suffer like so many people call Camden Chiropractic today to help ease your pain in North London.

Physiological Basis For Spinal Manipulation Explained By Leading Neurologist and Chiropractor, Scott Haldeman DC, MD, PhD

A recent post by BCA (British Chiropractic Association) president Richard Brown summarising the findings of highly regarded Neurologist and Chiropractor Scott Haldeman on the effects of spinal manipulation or adjustment.

by Richard Brown, BCA President on Friday, April 8, 2011 at 5:54am

The first day of the WFC’s 2011 Congress saw the legendary chiropractor and neurologist, Scott Haldeman, speak on the physiological mechanisms and effects of spinal manipulation. Dr Haldeman, a professor of neurology at the University of California and head of the Bone and Joint Decade 2000-2010, first qualified as a chiropractor in 1964 and has led the field in researching chiropractic and its effects since this time.

He said that there is now a large body of clinical research which demonstrates spinal manipulation to be effective in the management of back and neck pain and headaches.During his lecture, Dr Haldeman ran through a range of effects for which evidence now exists:

1. Relaxation of muscles and relief of muscular pain.

There have been a number of different research approaches to this question, but it’s been demonstrated that cortical evoked potentials are abnormal on the side of spinal pain when compared to the normal side and it’s been noted that these return to normal folowing spinal manipulation.

2. Changes in Pain Sensitivity

At least one study has shown that skin pain sensitivity to electricaql stimulation was diminished after spinal manipulation. A more recent RCT showed a change in thermal pain sensitivity.

3. Impact on Dorsal Horn neurons in the spinal cord.

Mechanical movement of the spine has been shown to stimulate Group I and Group II neurons and that the responses in these neurons can be sensitised by maintained changes in muscle length. Group III and IV Neurons can also be stimulated by vertebral movement. This has been hypothesized as a possible mechanism that may impact on the pain-spasm-pain cycle in paraspinal muscles.

4. Impact on Tissue Inflammatory Responses

Recent studies have raised the possibility that spinal manipualtion may have an impact on the inflammatory response of certain tissues.

5. Impact on Somato-Autonomic Responses

Research has repeatedly demonstrated that stimulation of somatic structures including peripheral somatic nerves, skin and muscles and can result in responses in autonomic nerves and can result in measureable changes in the function of a number of internal organs. It’s unknown whether or not these responses have any clinical significance.

Reference:

WFC 11th Biennial Conference Proceedings pp46-49

Slipped Disc/Disc Prolapse what is it and how can it be treated?

Slipped disc is a condition that is often severely painful and can often come on after very minimal, simple and insignificant movement such as bending over to pick a piece of paper up or get a towel off the floor. The term ‘slipped disc’ itself is technically incorrect as the disc does not slip, it does not act like a washer between the two vertebrae in the spine and ‘slip’ out of position. This view often leaves patients believing the disc can simply be put back in place. The correct term is a disc prolapse, protrustion or if very severe herniation.

I have seen a number of patients with true disc prolapses however, less than 1 in 20 cases of acute (sudden onset) back pain are due to a prolapsed disc. (Most cases on back pain are classed as ‘simple low back pain’. This is thought to be caused by a minor problem to a muscle, ligament, or other structure in the back also commonly helped by Chiropractic care). This is where a thorough examination and diagnosis is required to determine the cause of the pain.

What is a prolapsed disc?

When you have a prolapsed disc (commonly called a ‘slipped disc’), a disc does not actually ‘slip’. What happens is that part of the inner softer part of the disc (the nucleus pulposus) bulges out (herniates) through a weakness in the outer part of the disc. A prolapsed disc is sometimes called a herniated disc. The bulging disc may press on nearby structures such as a nerve coming from the spinal cord. Some inflammation also develops around the prolapsed part of the disc.

Any disc in the spine can prolapse. However, most prolapsed discs occur in the lumbar part of the spine (lower back). The size of the prolapse can vary. As a rule, the larger the prolapse, the more severe the symptoms are likely to be. (www.patient.co.uk)

Symptoms

Slipped disc is often a cause for severe pain usually burning, lancing or stabbing in quality, less so in the low back sometimes even without back pain. If the disc prolapsed is placing pressure on or irritating the nerve root, symptoms will be more into the legs which can include tingling, pins and needles, numbness and even weakness. A disc prolapse is often a cause of severe sciatica due to pressure on the nerve root (‘trapped nerve’) or inflammation causing chemical irritation of the nerve.

Diagnosis

If a disc protrusion is suspected, strength, reflexes, and sensation should be tested, further orthopaedic testing can be carried out when correlated with clinical findings this often leads to the diagnosis of a disc protrusion.

Some people do not have symptoms
Research studies where routine back scans have been done on a large number of people (some up to 70% of the population) have shown that some people have a prolapsed disc without any symptoms. It is thought that symptoms mainly occur if the prolapse causes pressure or irritation of a nerve. This does not happen in all cases. Some prolapses may be small, or occur away from the nerves and cause minor, or no symptoms

Treatment

  • Bed rest (brief), analgesics, and (conservative) Chiropractic treatment
  • Surgery for severe cases

Acute pain relief can come from 24 to 48 hours of bed rest in a recumbent position with the head of the bed elevated about 30° (semi-Fowler’s position). Measures used to treat low back pain, including non-opioid analgesics (eg, NSAIDs, acetaminophen), can be tried for up to 6 weeks including conservative Chiropractic care.

Surgery is indicated only for unequivocal disk herniation plus one of the following:

  • Cauda Equina Syndrome – Medical emergency immediate surgery is required.
  • Muscular weakness
  • Progressive neurologic deficit
  • Intolerable, intractable pain that interferes with job or personal functions in an emotionally stable patient and that has not improved after 6 wk of conservative treatment.

Research:

McMorland GSuter ECasha Sdu Plessis SJHurlbert RJ. Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study. J Manipulative Physiol Ther. 2010 Oct;33(8):576-84.

Sixty percent of patients with sciatica who had failed other medical management benefited from spinal manipulation to the same degree as if they underwent surgical intervention. Of 40% left unsatisfied, subsequent surgical intervention confers excellent outcome. Patients with symptomatic Lumbar Disc Herniation failing medical management should consider spinal manipulation followed by surgery if warranted.”

Li LZhan HSZhang MCChen BYuan WAShi YY.Systematic review of clinical randomized controlled trials on manipulative treatment of lumbar disc herniation. Zhongguo Gu Shang. 2010 Sep;23(9):696-700.

[Article in Chinese]

“This study shows that manipulative treatment on lumbar disc herniation is safe, effective, and both cure rate and the effective rate is better than other therapies.” However further high quality studies are required.

If you suffer with a disc protrusion (slipped disc), sciatica or low back pain and are seeing a professional and thorough diagnosis and treatment please give me a call at Camden Chiropractic and I will do my best to see you as soon as possible and get you out of pain and back to health.

Alex at Camden Chiropractic